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Shobha Yadav 1*
ABSTRACT
Schizophrenia is characterized mainly, by the gross distortion of reality, withdrawal from
social interaction, disorganization and fragmentation of perception, thoughts and emotions.
Insight is an important concept in clinical psychiatry, a lack of insight is particularly common
in schizophrenia patient. Previous studies reported that between 50-80% of patients with
schizophrenia do not believe, they have a disorder. By the help of psychological assessment,
we can come to know an individual’s problems especially in cases, where patient is hesitant
or has less insight into illness. Assessment is also important for the psychological
management of the illness. Knowing the strengths and weaknesses of that particular
individual with psychological analysis tools can help to make better plan for the treatment.
The present study was designed to assess the cognitive functioning, to elicit severity of
psychopathology, understanding diagnostic indicators, personality traits that make the
individual vulnerable to the disorder and interpersonal relationship in order to plan effective
management.
1
M.Phil., Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
*Responding Author
Received: May 30, 2017; Revision Received: June 20, 2017; Accepted: June 30, 2017
© 2017 Yadav S; licensee IJIP. This is an Open Access Research distributed under the terms of the Creative
Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any Medium, provided the original work is properly cited.
Understanding Schizophrenia: A Case Study
74%–81.9% after 5 years, if treatment were not performed adequately. The clinical
presentation of schizophrenia includes four separate sets of symptoms or behaviors:
delusions, hallucinations, thinking/discourse disorder, and negative symptoms. Emotional
intelligence is the indicator of mental wellness, which schizophrenic patient mostly feels
impaired.
The schizophrenia is a chronic mental illness, which, due to its severity, often poses a
problem for the individual-patient, his or her family and a wider community, a whole social
core. This illness poses a threat, causing difficulties in the functioning of the individual,
within one or more segments of the individual's life. Therefore on-time evaluation and
counseling is very important.
The present study was designed to assess the Cognitive functioning, to elicit severity of
psychopathology, understanding diagnostic indicators, personality traits that make the
individual vulnerable to the disorder and in order to plan effective management.
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 58
Understanding Schizophrenia: A Case Study
Study design:
Participant: The assessment was carried out with 30 year old, Hindu, unmarried male,
pursuing for MD pathology from higher socio-economic status hailing from urban Bihar with
nil contributory of family history, past history of mental illness in his mother and elder
brother but diagnosis was not clear due to lack of information. Pre-morbid personality was
not well adjusted with insidious onset, course continuous and progress deteoriating with
predisposing factor, continued stressors in the form of torture for stammering by his
classmate. Came here with the chief complaints of delayed language milestones, difficulty in
speaking from age of 4 years, withdrawn, behavior from 2004,suspicious attitude and anger
outbursts from 2011. Impact of illness present on the patient social, personal and family
adjustment.
After taking detail history about the patient illness psychologist has found that there is no
hearing of voices, seeing things no one else can see, smelling odors others can’t, sadness,
decreased energy, loss of interest in surroundings, reduced concentration and attention,
suicidal thoughts, increased talkativeness, increased psychomotor activity, increased
spending beyond means, racing thoughts, excessive worry, feeling anxious, restlessness,
racing heart, sweating, shortness of breath, sense of doom, checking, cleaning, organizing,
rituals, obsessive thinking, counting, nightmares, flashbacks, startle response, fear of spiders,
heights, planes.
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 59
Understanding Schizophrenia: A Case Study
impulses. He also has a sarcastic and suspicious attitude. Feels alienated, misunderstood, and
unaccepted. He does not feel part of his environment. He may be confused, disorganized and
disoriented. Feels resentful, hostile and aggressive. He feels insecure, inferior, incompetent
and dis-satisfied. Typically responds to stress by withdrawing into daydreams and fantasies.
He is very insecure and uncomfortable in social situations. He feels more comfortable alone
or with a few close friends. He is quite over-controlled and not likely to display feelings
openly.
• Harris Lingoes Sub scales of MMPI-2- revealed that he might be resentful towards
societal and parental standard and customs, thus having trouble with the law. He may feel
uncomfortable and unhappy. He may have problems of concentrating. Feels that other people
do not understand him. Feels depressed and in despair, tends to be restless, hyperactive and
irritable, and may be experiencing unusual thought content.
• Personality Psychopathology Five Scales (PSY-5) of MMPI-2: Indicate that he
might have delusions of reference, may feel alienated. He may also experience disconnection
from reality, has few or no friends. He might be verbally and physically aggressive, and may
often use this aggression to dominate and control others.
(B). Projective Tests:
• Draw A Person Test (DAPT): Test findings reveals, patient might have masculine
inadequacy, psychotic tendency, felt lack of status and low self-esteem. Maternal
dependence, somatic pre occupation problem with control of anger anxiety, insecurity
aggression, regression sexual inadequacy, pre occupation with sex compensation for felt
weakness, guilt dependent, oral erotic oral aggressive, simple schizophrenia sexual role
conflict, assertiveness, auditory hallucination, ideas of reference, paranoid tendency,
Schizophrenia paranoid grandiosity, manic tendency externalized aggression, paranoia.
• Sacks Sentence Completion Test (SSCT): Test findings indicate severe conflict in
the area of interpersonal, in the subarea of superior at work and school, Colleagues at work
and school and self-area in the sub area of Fears, Guilt feeling, Own abilities.
• Object Sorting Test (OST): Test findings indicate there are criteria met singular,
disjointed, and peculiar-an unrealistic use of an object, Fused-use a single concept to explain
the group of object sorted. Impoverished-poverty of association, Cumulative Active,
cumulative passive, which indicate that presence of thought deviance.
• Rorschach Inkblot Test: He might be experiencing some distress. He might be
apparently under considerable situational related stress, this impact on his overall
functioning. It signifies something about the processing effort and strategy. He might be
experiencing more seemingly random disconnected pattern of thinking than is customary,
these are usually provoked by the presence of more ungratified needs. He seems to have
excessive internalization of feeling and he would prefer to externalize, leading to anxiety.
This person may be striving to accomplish more than reasonable in light of his current
resources, which increases the probability of failure to achieve objectives, leading to
experience of frustration. He is very guarded and mistrustful and tries to minimize
involvement with any perceived ambiguity. He has significant mediational impairment and
impaired reality testing. He seems to be prone towards unconventional behavior, which is
most likely to be induced by forms of mediational dysfunction and problems in reality
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Understanding Schizophrenia: A Case Study
Positive findings:
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 61
Understanding Schizophrenia: A Case Study
Scales administered
Rationale: To assess the severity of psychopathology
• International Personality Disorder Examination (IPDE): As per the patient, there is a
probable diagnosis of schizotypal personality and avoidant personality. As per the
informants is schizotypal personality.
• The Positive and Negative Syndrome Scale (PANSS): Test findings indicate that
presence of positive and negative symptoms.
• Schizotypal Personality Questionnaire (SPQ): Test findings indicate presence of
schizotypal trait. Problem in cognitive perceptual which include ideas of reference, odd
beliefs, unusual perceptual experiences, paranoid ideas.
• Beck Depression Inventory (BDI): The patient’s responses were scored, which
indicated presence of mild depression.
Diagnostic indicators:
• Vigilant, mistrust of others and suspiciousness (Rorschach, MMPI, DAPT, IPDE, SPQ,
PANSS).
• Thought deviance, significant mediational impairment, poor reality contact. (Rorschach,
MMPI, OST, SPQ).
• Aggressive and problem with affective modulation (Rorschach, DAPT, MMPI).
• Poor interpersonal relationship (MMPI, Rorschach, BVMGT).
• Conflicts related to self (DAPT, SSCT).
DISCUSSION
Index patient has fair level of attention and concentration as well as visual motor co-
ordination. He might be having lack of feeling and empathy, hostile towards others, sensation
seeking, and liking odd and unusual things. He might be apparently under considerable
situational related stress; this impacts his overall functioning. He might be rebellious toward
authority figures, which leads to blames family members for any difficulties and result for
poor interpersonal relationship. He might be having lack of impulse control due to this strives
for immediate gratification of impulses. He seems to have excessive internalization of feeling
and he would prefer to externalize, leading to anxiety. He seems to have excessive
internalization of feeling and he would prefer to externalize, leading to anxiety. He seems to
have persistent difficulty with the modulation or control of emotions. He has negative
features in self-concept that promotes a pessimistic view of self. He also feels insecure,
inferior, incompetent and dissatisfied because of this he feels that other people do not
understand him and feels uncomfortable in social situations. He might be having feeling of
restless, hyperactive and irritable, and may be experiencing unusual thought content which
leads to presence of thought deviance. His thinking may tend to be disorganized, inconsistent
and is frequently marked by flawed judgements. Sometimes this may be accompanied with
bizarre conceptualizations, a mistrusting attitude towards environment and an extreme
concern with safeguarding personal integrity. Also he has significant mediational impairment
and impaired reality testing.
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 62
Understanding Schizophrenia: A Case Study
Psychological testing gives the test profile of the individual. The basic purpose of
psychological assessment revolves around prediction and diagnosis. Whether a diagnosis, can
be based on the psychological report of a patient remains an area of dispute. Indeed a
psychological report gives the diagnostic indicator of a patient. Some people such as, William
H. Hunt particularly stressed upon the diagnostic value of psychological tests. He said that
“Diagnostic testing is one area where the peculiar and unique competence of the clinical
psychologist is accepted by his colleagues in the clinical team”. Still, the diagnosis of patient
is seldom based upon the psychological assessment report as most of the psychological tests
are based on psychological constructs and not upon the diagnostic systems such as the DSM
or ICD.
CONCLUSION
Test findings indicate presence of poor reality contact, thought deviance, suspiciousness and
poor interpersonal relationship, suggestive of features of schizophrenia. These are some
prognostic factors, which are the predictor for the disorder. The good prognostic factor is
patient has adequate family support and the bad prognostic factor are the long duration of
illness and poor insight of the patient.
Acknowledgments
The author appreciates all those who participated in the study and helped to facilitate the
research process. I would also like to thank Dr Brijesh Yadav for his help in drafting and
reviewing manuscript.
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How to cite this article: Yadav S (2017), Understanding Schizophrenia: A Case Study,
International Journal of Indian Psychology, Volume 4, (3), DIP:18.01.148/20170403,
DOI:10.25215/0403.148
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 64